What is Reconciliation?

The Process

Where appropriate, patients, their family members, and carers should be involved.

Data Collection

• Medicines reconciliation should be completed within 7 days after discharge from hospital, asthe patient is likely to have only been discharged with a short course (as per CQC requirements)
• All hospital discharge letters that need to be reconciled are under:

‘Workflow’ → ‘Document Management’ → ‘Awaiting Filing’

• Any changes in medications as per the discharge letter should be updated onto the patient’s medication record on EMIS
• It is essential that any discrepancies in the discharge letter such as undocumented dose changes/medicines missed out/undocumented newly started medication are discussed with the secondary care team and resolved to ensure medicine and patient safety

Data Checking

When reconciling medications, the following information must always be considered and included:

• Contact details for relevant healthcare professionals/NHS Trust
• Known allergies and reactions to medicines or ingredients, including the type of reaction
• Both new and current medications including:
• Name
• Strength
• Form
• Dose
• Timing and frequency
• Route
• Indication
• Date and time the last dose of any ‘when required’ medicine was taken
• Information about any medication given less often than once daily (weekly or monthly medicines)
• Information given to the patient, family members, or carers
• When new medications (if there are any) should be reviewed, as well as monitoring requirements - it is important to note if there are any stop dates provided

Data Communication

• It is good practice to add a consultation on the patient’s record during the medicines reconciliation process to document any changes in the patient’s medications, any relevant monitoring or follow ups required, as well as updating it on their record
• All hospital letters must be filed after reconciliation by ‘marking them as viewed’ and ‘completing the task’
• For completion of reconciliation, a task should be sent to reception to book the patient with the clinical pharmacist for a medication review
• The clinical pharmacist is to ensure that the patient is made aware of all medication changes and is subsequently informed of any monitoring requirements that accompany these changes
• They are also to verify that the patient has sufficient medication, if there is any need for an acute prescription and that the patient’s review date has been appropriately updated
• A task is sent to reception to arrange an appropriate follow-ups required e.g. bloods, BP reviews, etc.
• These reviews follow the standards of ⭐Medication Reviews